In this episode, we review Zenker diverticulum, a posterior pharyngoesophageal outpouching that develops above the upper esophageal sphincter due to cricopharyngeal dysfunction. We break down the anatomy of the Killian triangle, the pathophysiology of increased intraluminal pressure leading to herniation, and the classic presentation of dysphagia, regurgitation of undigested food, and halitosis in older adults. The discussion highlights the diagnostic role of barium swallow imaging and reviews definitive management with endoscopic cricopharyngeal myotomy.

References

1) Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817.

2) Law R, Katzka DA, Baron TH. Zenker's Diverticulum. Clin Gastroenterol Hepatol. 2014 Nov;12(11):1773-82; quiz e111-2. doi: 10.1016/j.cgh.2013.09.016. Epub 2013 Sep 18. PMID: 24055983.

3) Nesheiwat Z, Antunes C. Zenker Diverticulum. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499996/